American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Sep 2007
Clinical TrialBotulinum toxin a, evidence-based exercise therapy, and constraint-induced movement therapy for upper-limb hemiparesis attributable to stroke: a preliminary study.
To determine whether the combination of botulinum toxin A (BTX-A) treatment for the upper limb and a 4-wk course of exercise therapy could improve motor function sufficiently to allow those with poststroke hemiparesis and spasticity to achieve the minimal motor criteria (MMC) to be enrolled in constraint-induced movement therapy (CIMT), and to determine the feasibility of enrolling participants into CIMT if they meet MMC after treatment with a combination of BTX-A plus exercise therapy. ⋯ BTX-A plus exercise therapy shows potential to improve function for those with severe hand paresis and spasticity after stroke. Those who meet MMC may initially realize further modest gains through CIMT. However, gains are likely to recede as spasticity returns. Adding medications or modifying the therapy protocol to include activities such as functional neuromuscular stimulation or robotic training may yield a more potent effect.
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Am J Phys Med Rehabil · Jul 2007
Predicting discharge of trauma survivors to rehabilitation: a sampling frame solution for a population-based trauma-rehabilitation survey.
To conduct a population-based survey among trauma survivors on accessibility to rehabilitation services in metropolitan, urban, and rural areas in Quebec (Canada), we attempted to use trauma registries as a sampling frame of subjects discharged to rehabilitation. Discharge destinations were inaccurate in many registries, preventing straightforward identification of the survey subjects. Using the best registry data, we aimed to identify predictors of rehabilitation discharge and to use them to specify a reliable sampling frame for the survey. ⋯ The procedure helped us bypass largely inaccurate data from trauma registries. The sampling frames reflected severely injured trauma survivors who were likely to have been referred to postacute rehabilitation.
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Am J Phys Med Rehabil · May 2007
Randomized Controlled TrialDry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs.
To investigate the changes in pressure pain threshold of the secondary (satellite) myofascial trigger points (MTrPs) after dry needling of a primary (key) active MTrP. ⋯ This study provides evidence that dry needle-evoked inactivation of a primary (key) MTrP inhibits the activity in satellite MTrPs situated in its zone of pain referral. This supports the concept that activity in a primary MTrP leads to the development of activity in satellite MTrPs and the suggested spinal cord mechanism responsible for this phenomenon.
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Am J Phys Med Rehabil · Apr 2007
Lung inflation by glossopharyngeal breathing and "air stacking" in Duchenne muscular dystrophy.
To compare the use of glossopharyngeal breathing (GPB) and air stacking to increase lung volumes and cough peak flows (CPF), and GPB to increase ventilator-free breathing ability (VFBA), for patients with Duchenne muscular dystrophy. ⋯ GPB and air stacking can increase lung volumes and, thereby, cough flows. GPB also can be used in many cases to delay and decrease daytime ventilator use.